March 2015 | www.cmsdocs.org

Advocating for You in Springfield

The Chicago Medical Society Gains Momentum

on GME Funding

Medicare Exits Fee-for-Service

E-Cigarette Regulation: Going

Up in Vapor?

2014 Legislative Recap Highlights Page 14

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Ashish Chopra, MD, Gastroenterology Cathy Lomelino McAfee, MD, Internal Medicine Grant Su, MD, FASOPRS, Ophthalmology

PreSident’S MeSSage2 The Road to ReformBy kenneth G. Busch, Md

young PhySiCianS3 The Struggle to Find BalanceBy Sameer Vohra, Md, Jd

PraCtiCe ManageMent4 HIPAA Compliance Obligations; Meaningful Use in 2015

PubliC health8 Opioid Prescribing in Illinois

legal10 E-Cigarette Regulation: Up in Vapor?By Michael kilpatrick Morgan, Jd

MeMber benefitS 26 Your Society Makes its Mark in Washington

28 Will Congress Deliver the “Doc Fix”?

30 Calendar of Events

31 New Members

31 Classifieds

Who’S Who32 No Time to Wasteneurosurgeon Richard W. Byrne, Md, makes the most of his precious time as professor and chairman of the department of neurosurgery at Rush Medical college and as medical director of university neurosurgery at Rush university Medical center.

Volume 118 issue 3 March 2015

featureS14 2014 Update on AdvocacyHighlights from the illinois State Medical Society’s legislative activity in the General assembly.

20 Medicare Exits Fee-for-Serviceas the percentage of payments linked to value grows rapidly, 50% of doctors soon will see their reimbursement eventually tied to performance, health outcomes of their patients, and to other measures. By Bruce Japsen

14

March 2015 | www.cmsdocs.org | 1

the road to reformMeSSaGe fRoM THe pReSidenT

the tSunaMi of change coming out of Wash-ington reminds us that not “all politics is local,” as the saying goes. And that’s why the Chicago Medical Society advocates for you at the county, state and national levels.

With the goal of influencing those who make decisions, CMS paid house calls on Capitol Hill last Feb. 23-25. Working both sides of the political aisle, we met our target of having personal contact with one-third of Illinois’ lawmakers.

Joining me were CMS President-elect Kathy M. Tynus, MD, and Tina Shah, MD, MPH.

Your CMS team conveyed what members tell us about day-to-day clinical situations. Each new regulation burdens the medical practice, adding to physicians’ mounting responsibilities. Distractions, whether from EMRs or a plethora of rules, interfere with patient care. Despite what politicians say, many of us believe the new regime is more concerned with raising revenue than encouraging quality.

As 2015 shapes up as the year of converging rules and penalties, CMS has made educating the 114th Congress a top priority. Nearly half of all U.S. House and Senate members came into office in 2010 or later, during a highly partisan era. Yet our agenda requires bipartisan support.

On some fronts, momentum is growing. GME expansion, for example, is one issue on which CMS is quite visible. Over two years’ time, U.S. House members of both parties agreed to sign on to critical GME legislation, thanks to CMS outreach. These bills would create new medical residency slots, with emphasis on primary care.

While in Washington, Dr. Shah gave a compelling firsthand account to our own Senator Richard Durbin. As chair of the AMA’s Resident and Fellow Section, Dr. Shah spoke with the authority of someone on the frontlines. This, along with her interest in hospital system operations and their impact on patient care, make Dr. Shah a uniqiue witness to the challenges facing academic medical centers, such as the University of Chicago, where she is a fellow in pulmonology and critical care.

Dr. Shah relayed horror stories of medical students unable to land residency training spots. The 1997 cap on Medicare-funded training put a stranglehold on the production of new physicians, not long before the nation’s health care needs began to soar, Dr. Shah said. Yet medical residents are the backbone of much hospital care and the future of medicine.

The second pillar of CMS’ Medicare reform plan calls for scrapping the SGR formula. And CMS renewed its pressure on lawmakers to reach a bipartisan solution. Like the residency cap, the funding mechanism was set in place in 1997. The good news is that Congress may soon put an end to the annual SGR drama.

Finally, CMS gave testimony in support of the 21st Century Cures Consortium. Also known as the Medical Innovations Act, this bipartisan effort would modernize the dis-covery, development, and delivery of new drug treatments. The initiative is sponsored by U.S. House Reps. Fred Upton and Diana DeGette. We were pleased to give input on how Congress can accelerate these changes.

The 21st Century Cures initiative marks a new point in the national conversation. Along the same lines, CMS asks that you join us at this turning point in medicine. As our health system shifts from fee-for-service to value-based care, we need your voice.

Kenneth g. busch, MdPresident, Chicago Medical Society

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Cheryl englandc o n t r i b u t o r s

Kenneth g. busch, Md; Clay J. Countryman, Jd; bruce Japsen; Michael Kilpatrick Morton, Jd;

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Chicago Medicine (issN 0009-3637 is published monthly for $20 per year for members; $30 per year for nonmembers, by the Chicago Medical society, 515 N. Dearborn st. Chicago, ill. 60654. Periodicals postage paid at Chicago, ill. and additional mailing offices. Postmaster: send address changes to Chicago Medicine, 515 N. Dearborn st., Chicago, iL 60654. telephone: 312-670-2550. Copyright 2015, Chicago Medicine. All rights reserved.

“three thingS will matter at the end of your career: (1) your relationship with your family; (2) your relationship with yourself; and (3) the impact you made on this world. each one is incredibly important but do not sacrifice any one of these three things to pro-mote the others. despite all the good i did for my patients, i sacrificed relationships with my family and because of that myself. and, i regret it every day.”

These words rang very loud during a quiet moment at the end of a very long neurosurgery clinic. i was just a third-year medical student then and not accustomed to hearing such honest, regretful words coming from a doctor, let alone one of the most respected neurosurgeons at our medical school. His advice came at the culmination of a conversation about my own ambitions as a student pursuing medical and law degrees. i spoke of the impact that i wanted to make on society and the difficult path that lay ahead of me. He understood my motivations and desires, but he felt that it was important that i heed his warning. This complicated and heroic man was imploring me to find balance in my life.

a disconnect often exists between my genera-tion of physicians and our elder counterparts. although i deeply respect the talent and dedica-tion of my senior physician mentors, they remind me that i have had a much easier time in training than they did. They hint and sometimes openly state that we are pampered by having to work only 80 hours a week with limited overnight call. They discuss how the priority of young doctors today in finding balance and wanting sufficient time for their families, friends, and hobbies is very different than their experiences many years ago. The older generation wonders if we have spent enough time seeing, learning, and experiencing diseases and their treatment. Many even question whether some of us have the same dedication for the craft that they did.

The truth is that today’s medical world is not the same one in which older physicians trained. Medi-cine, itself, is far more complicated than in the past, but it can be argued that the biggest difference is actually the physician culture. i acknowledge that my generation of physicians does have it easier in the work environment; 80 hours a week are more than enough, and i, for one, am glad that the term “resident” does not mean that i actually reside in the hospital.

i will not acknowledge, however, that our dedi-cation to the profession is any less than our elder

counterparts’. My young physician group has a powerful desire to shape and positively impact the lives of patients and society. We study and train to heal the sick, maintain the well, and find innovative solutions to build a healthier country and world. We often get additional degrees and spend more years in sub-specialization honing our craft to best serve our patients. Many of us also believe that spending more time with ourselves and our families makes us happier people and thus better doctors in the end.

despite this knowledge and understanding, i openly admit that finding balance is very difficult. My wife has her own career to manage and with a daughter at home, i struggle finding enough time to be everything to everyone. i do my best, but it is often difficult to find the equal and adequate ratio for each task. in the end, i hope that i am doing justice to each of my responsibilities and that they complement each other, making me a better doc-tor, husband, and father. only time will tell if this hope becomes true.

i often think about that cold winter day in the medical school neurosurgery clinic and about that honest conversation with a highly respected physician. our roads diverged that day, and i never had the chance to talk to that neurosurgeon again, but i hope that he found peace with his family and within himself. He took the time to teach me a valuable lesson for which i will always be thankful. although i am far from perfect, i am proud that i struggle to find balance in my life. There will be a time when i give that same life advice to a young third-year medical student. My hope is that i do it without any regrets.

Sameer Vohra, MD, JD, is a fourth-year resident physician in pediatrics and public policy at the University of Chicago/Comer Children’s Hospital. He is a Fulbright Scholar, has worked for the Centers for Disease Control and Prevention’s Public Health Law Program, and completed fel-lowships for the American Pediatric Society for Pediatric Research and the American Academy of Pediatrics (AAP) Department of Federal Affairs. Dr. Vohra currently sits on the AAP-SOMSRFT National Executive Committee and on the Chi-cago Medical Society Board of Trustees. He has previously served on the National Administrative Board for the Association of American Medical Colleges Organization of Student Representa-tives. In 2014, Dr. Vohra was a recipient of the AMA Foundation Excellence in Medicine Leader-ship Award.

the Struggle to find balancefor physicians, managing the demands of work and life can be the ultimate challenge By Sameer Vohra, MD, JD

younG pHySicianS’ peRSpecTiVe

March 2015 | www.cmsdocs.org | 3

pRacTice ManaGeMenT

PhySiCian practices face many challenges in complying with the HIPAA Privacy and Security Rules that apply to patient information used by practices to treat patients and coordinate services with other providers. A common question by

physicians and practice administrators is what components should be part of a HIPAA compliance program, at a minimum, to avoid fines and penalties under the HIPAA Rules.

Although an answer to this question generally depends on the size and specialty of a physician’s practice, as well as many other factors, information requested by the Office for Civil Rights (OCR) during a HIPAA investigation, and resolution agreements in settlements by the OCR of HIPAA violations, offer good examples of a framework and minimum components for a physi-cian practice HIPAA compliance program.

For example, the following is a list of common information requests by the OCR in the initial stages of an investigation. This list may also serve as part of a checklist for a practice’s HIPAA compliance program:

• Name and contact information of the privacy officer.• Evidence of any internal investigation (timeline of events,

persons interviewed, dates, outcome, and relevant documents).• Any mitigation factors that were employed.• A copy of any risk assessment of any alleged breach of

patients’ protected health information (PHI).• Copies of any policies and procedures regarding safeguarding

of PHI.• Copies of any policies and procedures regarding disclosure

of PHI.• Information about any sanctions imposed on any employees.

On April 13, 2012, the OCR entered into a settlement and corrective action plan with a cardiothoracic surgeon’s practice in Phoenix, Arizona, based on certain violations of the HIPAA Privacy and Security Rules. The OCR required the practice to take several actions, including adoption of written policies and procedures to bring the practice into compliance with the HIPAA Rules.

The following actions identified in the resolution agreement for this practice’s settlement agreement highlight possible areas of physician practice operations that may subject the practice to liability under the HIPAA Rules. The OCR specifically noted that this cardiothoracic practice:

• Failed to provide and document training to each workforce member on required policies and procedures with respect to PHI as necessary and appropriate for each workforce member to carry out his or her responsibilities.

• Failed to have in place appropriate and reasonable admin-istrative and technical safeguards to protect the privacy of patients’ PHI.

• Failed to implement required administrative and technical security safeguards for the protection of electronic PHI.

• Failed to identify a security official.

• Failed to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity and availability of the ePHI held by the practice.

• Failed to obtain satisfactory assurances in business associates agreements.

A common requirement in resolution agreements between the OCR and health care providers in HIPAA enforcement cases is a require-ment that a provider adopt written policies and procedures that ensure administrative, physical and technical safeguards to protect both non-electronic (hard copy) and electronic patient information (protected health information). These policies should generally address all types of patient information used and disclosed by a physician practice, including the disposal of patient information.

In addition, physician practices (and all health care providers) should focus their compliance efforts on the following areas of the HIPAA Security Rule:

• risk analysis and risk management. Conduct a thorough security risk analysis and risk management plan, identifying and addressing the potential risks and vulnerabilities to all electronic PHI.

• Security assessments. Conduct periodic security evaluations and ensure that appropriate physical and technical safeguards remain in place, including office moves or renovations, and conduct appropriate technical evaluations for software, hard-ware, and websites upgrades that may impact PHI.

• Portable electronic devices. Safeguard PHI stored and trans-ported on portable electronic devices, such as through encryption.

• Physical access controls. Verify that physical safeguards limit access to facilities and workstations used to maintain or access PHI.

• disposal of patient information. Adopt policies and procedures for the proper disposal of PHI in both paper and electronic forms. Electronic devices and media (laptops, copy machines, fax machines) that may contain PHI should be purged or wiped before they are recycled, discarded or returned to a third party, such as a leasing agent.

The items described above are just a few of the available sources practices can use as a guide in determining what is needed in their HIPAA compliance programs. Copies of resolution agreements from settlements of HIPAA enforcement actions are available on the OCR website at www.hhs.gov/ocr/privacy.

Clay J. Countryman, JD, is a partner with Breazeale, Sachse & Wilson, LLP, in Baton Rouge, Louisiana. He can be emailed at Clay.Countryman@bswllp.com. This article is intended for infor-mational purposes only, and does not and should not be construed as legal advice on the topics addressed.

hiPaa Compliance obligations A guide to identifying and prioritizing the components of a compliance program By Clay J. Countryman, JD

in thiS neW monthly column attorney clay J. coun-tryman will address compliance issues for the medical practice.

4 | Chicago Medicine | March 2015

S.M.i.l.e.(saving More illinois Lives through education)A project of the Chicago Medical society and the illinois state Medical society, supported by the American heart Association

handS-only CPr giVen ProPerly and iMMediately to ViCtiMS of Sudden CardiaC arreSt Can SaVe liVeS• Less than 8% of people who suffer cardiac arrest outside of a hospital survive.• Less than 33% of out-of-hospital sudden cardiac arrest victims receive bystander cpR.• effective bystander cpR, provided immediately after sudden cardiac arrest, can double or triple a victim’s chances of survival.• The mission of SMiLe is to disseminate information to the general public about the importance of learning basic emergency

resuscitation skills such as “hands-only” cpR.

tWo SiMPle StePS—handS-only CPr:1. Call 9112. Start CheSt CoMPreSSionS, PuSh hard and PuSh faSt (at least 100 times/min)

if you are interested in organizing a SMiLe presentation in your community or interested in becoming a SMiLe volunteer, contact Meredith oney at the chicago Medical Society 312-670-2550, ext. 326, or email oney@cmsdocs.org.

Many PhySiCianS are anx-iously waiting to hear from the Centers for Medicare and Medicaid Services (CMS) on how long the reporting period will be for Mean-

ingful Use in 2015. On Jan. 29, the federal CMS indicated it will reduce the period to 90 consecutive days for 2015 but this has not been finalized. As of late March, the reporting period remains for the entire year regardless of the stage.

Stage 2 has the same structure as Stage 1. Now, however, eligible professionals (EPs) must report on 17 core objectives and three out of six menu objectives. Some of the most significant changes between Stage 1 and Stage 2 are the increased thresholds for many of the objectives. Few of the measures have exclusions, thus making it more difficult for EPs to meet the objectives. Most of the new items for Stage 2 are the menu objectives. New criteria for summary of care, transition of patients and e-prescribing all lead to major changes; health

information exchange plays a large part in meeting Stage 2 measures. EPs can expect the changes associated with achieving meaningful use to alter workflow and their use of technology. The chart below shows all the objectives, thresholds and exclusions for Stage 2 in 2015.

Physicians are worried that if they do not meet the objectives for the entire year they will not only miss out on incentive payments, but also will face the risk of payment adjustment. Depending on what year an EP began participating in meaningful use determines the incentive payment schedule. However, failure to report in 2015 leads to a payment adjustment in 2017.

Christine O’Malley is a health care consultant with PBC Advisors, LLC, in Oak Brook. PBC Advisors provides business and management consulting and accounting services to physician practices and hospital systems. For more information, visit www.pbcgroup.com.

Meaningful use in 2015stage 2 requirements increase thresholds for many objectives By Christine O’Malley

pRacTice ManaGeMenT

# objective Measurement exclusion

1 Submit electronic syndromic surveillance data.

Successfully submit syndromic surveillance data to a public health agency throughout the eHR reporting period on an ongoing basis.

1) does not collect ambulatory syndromic surveillance info on patients; 2) operate in jurisdiction for which no public health agency is capable of receiving electronic syndromic data required by eMR; 3) operate in jurisdiction where no public health agency is capable of receiving data; 4) operate in jurisdiction for which no public health agency is capable of accepting specific standards required by eMR.

2 Record electronic notes in patient records.

More than 30% of patients. no exclusions

3 imaging results accessible through ceHRT.

More than 10% of all tests whose results are one or more images.

fewer than 100 tests that yield an image or don’t have access to electronic imaging.

4 Record patient family health history.

More than 20% of all unique patients have structured data entry for one or more first degree relatives.

do not conduct office visits.

5 identify and report cancer cases to state cancer registry.

ongoing submission of cancer case information from ceHRT to public health cancer registry.

1) do not diagnose or directly treat cancer; 2) operate in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information in the specific standards required for your eMR; 3) operate in a jurisdiction where no public health agency for which you are eligible provides timely info on the capability to receive electronic info; 4) operate in a jurisdiction for which no public health agency is capable of receiving electronic cancer case info in the specific standards required for your eMR can enroll additional ep.

6 identify and report specific cases to specialized registry.

ongoing submission of cancer case information from ceHRT to public health specialized registry.

1) do not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society or the public health agencies in your jurisdiction; 2) operate in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which you are eligible is capable of receiving electronic specific case information in the specific standards required by your eMR; 3) operate in a jurisdiction where no public health agency or national specialty for which you are eligible provides timely info on the capability to receive; 4) operate in a jurisdiction for which no specialized registry is capable of receiving electronic specific case info required by your eMR.

Source: Centers for Medicare and Medicaid Services

Menu Objectives: report on three

6 | Chicago Medicine | March 2015

# objective Measurement exclusion

1 computerized provider order entry (cpoe).

More than 60% medication, more than 30% lab, and 30% radiology.

fewer than 100 medication, radiology and lab orders.

2 Generate and transmit prescriptions electronically or e-prescribe (eRx).

More than 50% of all prescriptions written compared to drug formulary and sent electronically using eMR.

Write fewer than 100 prescriptions.

3 Record demographics More than 80% have language, gender, race, ethnicity & date of birth.

no exclusions

4 Record vital signs More than 80% for patients age three and over have blood pressure, height and weight.

can be excluded from recording all three vital signs if: 1) you don’t believe these vital signs are relevant to your scope of practice; 2) can also be excluded from recording just blood pressure if you don’t believe blood pressure is relevant for your practice; 3) Just height and weight if you don’t believe height and weight are relevant for your practice; 4) excluded from recording blood pressure if you see no patients age three or older.

5 Record smoking status More than 80% for patients age 13 and over. do not see patients age 13 and older.

6 clinical decision support rule

1) implement five clinical decision support interventions related to four or more clinical quality measures; 2) enable drug-drug and drug-allergy interaction checks.

1) no exclusion for first objective; 2) Write fewer than 100 medication orders.

7 provide patients ability to view online, download and transmit their health information.

More than 50% provided access to their health info within four business days.

do not order or create any of the required information.

8 provide clinical summaries for patients for each office visit.

More than 50% within one business day from visit.

do not conduct office visits.

9 protect electronic health information created or maintained by eMR.

Meet the same Hipaa requirements using eMRs as you do with paper records. conduct security review of your system, correct and create action plan.

no exclusions

10 incorporate clinical lab test results.

Results from over 55% of lab tests ordered dur-ing the reporting period are recorded in the eHR as structured data—as long as the tests yield a number or a positive/negative response.

did not order any lab tests during the reporting period or if none of the results from the tests you ordered came back as a number or as a positive/negative response.

11 Generate list of patients by specific condition.

Generate relevant list of patients using the eMR. no exclusions

12 Reminders for preventive/follow-up care.

More than 10% of all unique patients who have had two or more office visits with the ep within the 24 months before the beginning of the eMR reporting period were sent a reminder.

no office visits 24 months before the reporting period.

13 patient-specific education More than 10% of your patients use education resources from the eMR.

do not conduct office visits.

14 perform medication recon-ciliation

More than 50% of patients you see after receiving care from another provider; you should update medication information by comparing the patient’s medical record to an external list of medications obtained from a patient, hospital or other provider.

did not see any patients after they received care from another provider.

15 provide a summary of care record for each transition of care or referral.

Summary of care record for more than 50% of transitions of care and referrals; 2) for summary of care documents you send, more than 10% must be sent electronically, either directly to a recipient or using the eHealth exchange standards; 3) at least one of the summary of care documents that is sent electronically must be sent to someone who is using a completely different eMR vendor or to the cMS-designated test eMR.

Transfer a patient to another setting or refer a patient to another provider less than 100 times during the report-ing period.

16 Submit electronic data to immunization registries.

Successful ongoing submission of electronic immunization data from ceHRT to an immunization registry.

1) do not administer immunizations; 2) operate where no immunization registry is capable of accepting data.

17 Secure electronic messag-ing.

a secure message was sent using the electronic messaging function of ceHRT by more than 5% of unique patients.

do not conduct office visits.

Source: Centers for Medicare and Medicaid Services

Core Objectives: report on All 17

pRacTice ManaGeMenT

March 2015 | www.cmsdocs.org | 7

puBLic HeaLTH

for doCtorS treating complaints of severe pain, prescription opioids can be an important tool.

In its policy paper on prescription drug abuse, the American College of

Physicians emphasized that the “challenge for physicians and public policymakers is how to deter prescription drug abuse while maintaining patient access to appropriate treatment.” Both the Illinois State Medical Society and Chicago Medical Society are educating their members about safe opioid prescribing. At the same time, we are working with lawmakers who have proposed increased restric-tion and monitoring. In February of this year, ISMS responded to several of these provisions to further restrict opioid prescribing. The ISMS paper contains a number of sensible recommendations tp lawmakers. (For the full report with footnotes and citations, please go to www.isms.org.)

heroin Crisis task force Illinois lawmakers, in concert with federal law, have provided a foundation of balanced regulation that has deterred the proliferation of “pill mills” that have plagued other states, according to the Centers for Disease Control and Prevention (CDC). However, the steep increase in both heroin use and heroin-related deaths in Illinois prompted a series of hearings last year. The House Task Force on the Heroin Crisis, chaired by Democratic Majority Leader Rep. Lou Lang, sought input from law enforcement officials, public health organizations, and the families of the victims of heroin abuse. During these hearings, the Task Force heard testimony identifying prescription opioids as one “gateway” to heroin use.

In follow-up, legislators introduced the Heroin Crisis Act, or HB 1. It was in an amendment to HB 1 that Representative Lang added provisions to further restrict opioid prescribing. 

new Physician MandatesAmendment 1 to HB 1 mandates continuing medical education requirements for physicians. The CME requirements include:

• The opioid education must be part of the cur-rent 150 hours of CME already needed for each three-year licensure cycle. The CME mandate does not apply to any other prescribers besides physicians.

• The topics of this CME may include: best prescribing practices for pain management; the risks of overprescribing and under-prescribing; medication abuse; screening and signs of addic-tion; and responding to addiction.

Prescribers are required to register with the Prescription Monitoring Program (PMP) as a condition of obtaining or renewing a controlled substance license. The amendment requires the Illinois Department of Financial and Professional Regulation (IDFPR) to adopt rules by Jan. 1, 2016, regarding the oversight of prescriber practices as reported to the PMP.

In other provisions, IDFPR is required to establish actions to be taken if a prescriber’s EMR system does not effectively interface with the PMP within the timeframe established by the bill. IDFPR will also adopt rules allowing prescribers who are registered with the PMP to authorize a designee to consult the PMP on their behalf. The amendment also expands the use of naloxone and ways to dispose of unused opioids.

iSMS recommendationsAs lawmakers were conducting hearings, over the summer ISMS developed a policy paper outlining its recommendations on how to address the misuse of opioids. The policy paper also includes ways that the Illinois PMP can be improved as a clinical tool. ISMS presented the recommendations in a February 2015 report to the Illinois House Task Force on the Heroin Crisis and to the Illinois General Assembly.

Here’s a brief recap of ISMS’ recommendations:

• Expand and strengthen Illinois’ PMP. ISMS has identified several strategies to expand the PMP’s use and effectiveness.

• Present new CME opportunities for opioid prescribers.

• Increase prescribers’ access to educational opportunities and information by developing the PMP as a vehicle for sharing such material.

• Increase access to naloxone, a medication used to counteract opioid and heroin overdose.

• Make naloxone more accessible to law enforce-ment, family members of at-risk patients and other first-responders.

• Promote safe medication disposal sites. • Expand patient education and options for medi-

cation disposal to help keep addictive medica-tions out of abusers’ hands.

• Access federal grant support to expand the PMP, access to naloxone, and medication dis-posal sites.

how illinois Compares to other StatesRecent data demonstrates that Illinois prescribers, when compared to their peers in other states, have prescribed fewer opioids, such as oxycodone. A

opioid Prescribing in illinoisAs lawmakers seek more restrictions, isMs provides framework for new law

8 | Chicago Medicine | March 2015

puBLic HeaLTH

review of prescription drug use in 2013 by IMS Health Inc. found that Illinois ranked 50th out of the 50 states, plus Puerto Rico and the District of Columbia, for oxycodone utilization. Of the total oxycodone prescriptions issued in 2013, Illinois had a per capita use of only .05.

In contrast, Tennessee had over six times as much utilization of oxycodone per capita, ranking at third in the nation with a .31 utilization rate per capita. Oxycodone prescriptions actually decreased 4% in Illinois from 2012 through 2013, an IMS Health Inc. comparison reported. For all Schedule II controlled substance utilization in 2013, Illinois was ranked 48th in per capita usage, IMS Health Inc. noted in another report.

Lawmakers in Illinois have also taken a proac-tive approach to combat prescription drug abuse with the implementation of the PMP. Started in April 2000, the PMP is a database that allows prescribers to view a patient’s prescription drug history, as reported by dispensers in Illinois and 25 other states. As a unit within he Illinois Department of Human Services, the Illinois PMP has been able to reduce the number of individuals who “doctor shop” by 66% since 2008, according the Office of Management and Budget.

Prescription Monitoring ProgramFor prescribers in Illinois, the main information clearinghouse regarding their patients’ prescrip-tions is the PMP. The PMP has two main functions: the collection of data from dispensers of Schedule II through V controlled substances and the main-tenance of a central repository of that information, which is made available for view by prescribers through a free website.

Dispensers are required to submit specific information to the Illinois PMP, including the patient’s name, address, sex, the date the prescrip-tion was filled, the payment used by the patient, and details about the prescription itself. This data must be transmitted to the Illinois PMP not more than seven days after the date on which a controlled substance is dispensed. The Illinois PMP updates its data every Friday. Users of the Illinois PMP must log-in to the system and then enter a patient’s name manually to view PMP information. The accuracy of this search depends on how the patient’s name was entered by a pharmacy or dispenser. For example, if a pharmacy enters a shortened patient name (Bill instead of William), the prescriber may not be able to locate the information on the PMP.

Illinois has been able to facilitate both the trans-fer of its PMP data and the receipt of data from other states by joining the National Association of Boards and Pharmacy (NABP) PMP InterConnect. With the data available on the NABP InterConnect, authorized PMP users in Illinois can gain access to data from other participating states through the Illinois PMP portal.

Besides Illinois, 25 other states participate in the NABP InterConnect, including Indiana, Wisconsin, and Kentucky. Illinois has also recently improved the PMP as a resource that can prevent “doctor shopping” by authorizing the PMP to issue an unsolicited report to prescribers when a person has been identified as having six or more unique pre-scribers or six or more unique pharmacies within the course of a continuous 30-day period.

While Illinois was a leader in developing its PMP in 2000 and has continued to improve the PMP by connecting our data with surrounding states, the Illinois PMP program still has shortfalls. The ISMS recommendations offer suggestions for improving its effectiveness as a tool to deter and prevent prescription opioid abuse.

Perils of Codifying Practice guidelinesThe ever-advancing science of medicine requires that physicians and all prescribers have access to the most up-to-date clinical guidelines for the treatment of pain. Since the initial introduction of opioids like hydrocodone into the U.S. drug market, these guidelines have evolved.

The field of pain management provides examples on the danger of codifying practice guidelines into legislation. Medical studies on the use of prescription opioids have evolved from a time when physicians were criticized for “under treating” pain to the development of prescription opioids like hydrocodone and oxycodone, and studies that proclaimed the opioids’ ability to treat non-cancer pain, according to a 2014 article in New York Magazine. In the midst of the current high rates of opioid-related overdoses, many have pointed to a seminal study performed in 1986 which “opened the door to more liberal prescribing of opioids,” as reported in MEDPAGE Today (Sept. 29, 2014). This study not only identified opioids as providing effective pain relief, but that they also posed a minimal risk for addiction.

Physicians, policymakers, and public health organizations now struggle to address the fall-out from the liberal prescribing of opioids, which were once treated with healthy skepti-cism, then embraced, and are now maligned. This scenario demonstrates that solidifying practice guidelines on any medical subject is dangerous because it makes medical concepts static, when they need to evolve based on comprehensive, peer-reviewed studies.

This article is adapted and excerpted from the Illinois State Medical Society “Recommendations for Deterring Improper Use of Opioids.” The detailed report was presented to the Illinois House Task Force on the Heroin Crisis, and the Illinois General Assembly in February 2015. To read the full ISMS report, including footnotes and citations, please go to www.isms.org.

March 2015 | www.cmsdocs.org | 9

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e-Cigarette regulation: up in Vapor? Lack of a federal policy creates a potential federal-state supremacy issue By Michael Kilpatrick Morton, JD

the federal regulatory frame-work for cigarettes and other tobacco products, one of the most comprehen-sive regulatory regimes currently in effect, has a new smokescreen to feel

its way through, as more and more people try to find a way to overcome their addiction to nico-tine–electronic cigarettes (e-cigarettes). However, a side-effect of the rise in the production and marketing of e-cigarettes and other vapor prod-ucts is that these products are making their way into the hands of minors, with different fruit and candy flavors. The confusion surrounding their federal regulation, taxation, and state regulation is caused in large part by not knowing what these products actually are.

As of March 2015, the FDA had not published a final rule either defining e-cigarettes or vapor products or expanding the definition of “tobacco products” to include e-cigarettes and other vapor products. In response to the slow-turning wheels of the federal government, several states, includ-ing Missouri, New York, and Vermont, have passed legislation that will likely conflict with the final FDA regulations. This article focuses on the Missouri law, the newest law enacted to address this issue.

e-Cigarettes and Vapor Products in youthIn a Morbidity and Mortality Weekly Report from November 2014, the Centers for Disease Control and Prevention (CDC) analyzed the results of the 2013 National Youth Tobacco Survey. In 2013, 22.9% of high school students reported current use (at least one day in the past 30 days) of at least one tobacco product. Of all high school students surveyed, 4.5% reported e-cigarettes as one of their “tobacco” products of choice; 0.6% of high school students reported solely using e-cigarettes. Of all middle school students surveyed, 2.9% reported e-cigarettes as one of their “tobacco” products of choice and only 0.4% reported solely using e-ciga-rettes. Coupled with the rest of the numerical data, it is inferred that minors who use e-cigarettes are also concurrently using another tobacco product.

While the survey studied tobacco use among middle and high school students, the CDC included e-cigarettes and other non-tobacco vapor products as a separate subset of data. This data suggests that as minors find alternatives to conventional tobacco products, federal regulatory action is necessary; however, classifying a non-tobacco product that contains nicotine is more difficult than one would think.

The federal government has been clear in its messaging: a stringent regulatory framework is needed to regulate the marketing and sale of e-cigarettes. In a letter dated Aug. 1, 2014, Congress pushed FDA Commissioner Margaret Hamburg to enact a strict final rule under the Family Smoking Prevention and Tobacco Control Act, more than five years after its passage.

This Act gives the FDA the authority to publish regulations on the sale and marketing of all tobacco products, which includes the ability to define “tobacco product” to include e-cigarettes and other vapor products. The letter, which noted that the percentage of minors who had tried e-cigarettes more than doubled from 2011 to 2012, asked Commissioner Hamburg to expedite the finalization of a proposed rule. Published on April 25, 2014, the proposed FDA rule would, among other things, prohibit sales of e-cigarettes to minors.

In his annual report, acting U.S. Surgeon General Boris Lushniak admitted that while the scientific research surrounding e-cigarettes is still unclear, nicotine has adverse effects on adolescent brain development, making the presence of nico-tine in e-cigarettes unsafe for youth. If and when the FDA implements a final rule on the marketing and sale of all tobacco products, such action will subsequently affect the taxation policy surrounding e-cigarettes and vapor products indirectly, since the FDA wants to include e-cigarettes within the definition of tobacco products.

fda regulation and the federal food, drug, and Cosmetic actUnder the proposed rule, the FDA would deem tobacco products subject to the Federal Food, Drug, and Cosmetic Act. The FDA claims it can regulate product standards of deemed tobacco products that fall under the federal definition of “tobacco product” by the authority given to it by the Federal Food, Drug, and Cosmetic Act. Under federal law, “tobacco product” refers to “any product made or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product.” The FDA states that e-cigarettes would fall under that definition, and therefore be subject to FDA regulation because of their nicotine content.

The FDA acknowledges that “customarily marketed tobacco products”—those not for therapeutic purposes—are currently subject to the Tobacco Control Act, and fall under FDA authority. However, e-cigarettes and other vapor products are not yet included in the definition of “tobacco

“Classifying a non-tobacco product that contains nicotine is more difficult than one would think.”

10 | Chicago Medicine | March 2015

“Some states have acted in a more timely fashion, defining e-cigarettes and vapor products in such a way as to fall outside of existing tobacco regulations and taxation frameworks.”

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product.” A rule that deems e-cigarettes and other vapor products to be tobacco products subject to the Federal Food, Drug, and Cosmetic Act would fix that problem. But until the FDA publishes a final rule, e-cigarettes will go largely unregulated in terms of product standards, age restrictions on sales, and marketing. 

Show-Me State opts not to WaitSome states have acted in a more timely fashion, defining e-cigarettes and vapor products in such a way as to fall outside of existing tobacco regulations and taxation frameworks. For example, Vermont includes e-cigarettes in its definition of “tobacco substitute.” The state included this in omnibus taxation legislation, with the goal of taxing tobacco substitutes at 92% on the wholesale market. However, though HB 884 passed both state houses and was signed by the governor, “tobacco substitutes” language was removed from the list of products to be taxed at 92%.

The Missouri legislature went further and passed SB 841 during the 2014 legislative session, prohibiting the sale of e-cigarettes and vapor prod-ucts to minors and exempting them from federal tobacco regulation or taxes. SB 841 created new definitions to exempt e-cigarettes and other vapor products from federal tobacco regulation.

new definitions for e-Cigarettes and Vapor Products

The legislation now defines an alternative nicotine product as:

• Any non-combustible product containing nicotine that is intended for human consump-tion, whether chewed, absorbed, dissolved, or ingested by any other means.

• An alternative nicotine product does not include any vapor product, tobacco product or any product regulated as a drug or device by the FDA under chapter V of the Food, Drug, and Cosmetic Act.

• By specifically removing vapor products from this definition, the Missouri legislature created a new subgroup of non-combustible products that contain nicotine, thus circumventing any impending federal FDA regulation.

The bill also differentiated vapor products from alternative nicotine products by providing a sepa-rate definition, which defines vapor product as:

• Any non-combustible product containing nicotine that employs a heating element, power source, electronic circuit, or other electronic, chemical or mechanical means...that can be used to produce vapor from nicotine in a solution or other form.

• Any electronic cigarette, electronic cigar, elec-

tronic cigarillo, electronic pipe, or similar prod-uct or device and any vapor cartridge or other container of nicotine in a solution or other form that is intended to be used with any electronic cigarette...or similar product or device. However, a vapor product does not include any alternative nicotine product or tobacco product.

These two definitions, taken together, create a new group of products to be regulated, but on the state level, rather than by the FDA. The Missouri legislature did the same with other provisions. The bill prohibits the taxing or regulation of alternative nicotine and vapor products as tobacco products, except for local and state sales taxes.

That statutory change exempts these products from Missouri’s 17-cent sales tax on tobacco products and from federal regulation under the Federal Food, Drug, and Cosmetic Act, since vapor products are not tobacco products or alternative nicotine products in Missouri. The state also acted on the issue of sale of vapor products to minors before the FDA could publish a final rule. The leg-islation further prohibits sales of both alternative nicotine products and vapor products to minors.

looming federal Showdown?While Missouri’s prohibition would bar any nicotine product from reaching the hands of minors, not everyone was pleased. In his veto, Missouri Governor Jay Nixon claimed that “[SB 841] would limit any additional state regulation of these products and would contravene pending federal regulations.” The Governor further insinuated that “this prohibition may be part of a larger strategy by the tobacco industry to stop the implementation of FDA regulations or ensnare them in protracted litigation.

Thus, if the proposed FDA regulations are pub-lished as proposed, SB 841 would contradict the regulations because new Missouri law prohibits the regulation of alternative nicotine products or vapor products as tobacco products. This would present an issue of preemption—Missouri cannot have a law that contradicts the FDA regulation defining e-cigarettes and other vapor products as tobacco products.   

States Wait for a final rule Many interested parties are waiting for the FDA to publish and implement a final rule on its authority under the Federal Food, Drug, and Cosmetic Act. Whether other states seeking to enact similar legislation will wait until the FDA publishes its final rule remains unknown. Nevertheless, the final rule will have a great impact on the federal government, the tobacco industry, and state legislatures.

Michael Kilpatrick Morton, JD, is counsel for the Nevada Legislative Counsel Bureau in Carson City.

March 2015 | www.cmsdocs.org | 11

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year in review

14 | Chicago Medicine | March 2015

2014 Update on Advocacy Highlights from the Illinois State Medical Society’s 2014 legislative activity in the Illinois General Assembly

JUst As the Chicago Medical Society (CMS) is the only organization representing all physician specialties in Cook County, the Illinois State Medical Society (ISMS) is the only body to represent all physician medical specialties across Illinois. Working together,

we tackle a wide variety of issues. In this section, we recap some of the major initiatives we

fought for or against in 2014 on your behalf. (For the full list, please check the ISMS website at www.isms.org).

The legislative victories described here would not be possible without grassroots county medical societies like CMS. As the point of origin for many state initiatives, counties and their indi-vidual members first identify problems, and then, through the resolutions process, offer solutions to the vexing issues at hand.

Resolutions often form the basis of legislative proposals. CMS submits such measures every spring for deliberation by the ISMS House of Delegates. Participating in CMS’ robust resolutions process, physician-members have launched dozens of initiatives on behalf of patients and the medical profession.

As you review this recap, consider what the outcomes could have been without ISMS and CMS advocacy. Many bills discussed in these pages never made it to your morning paper or smartphone news feed.

Physicians have the power to make a positive difference and the responsibility to defend against bad medical policy—and it is through the Chicago Medical Society and the Illinois State Medical Society that we can best do so.

INsURANCe AND thIRD PARtY PAYeR IssUes

Insurance Coverage for telemedicine Senate Bill 3319 (Sen. Harmon) and House Bill 5313 (Rep. Feigenholtz), both initiatives of ISMS, were introduced as mea-sures to increase access to medical care for patients in rural and other underserved areas by requiring health plans and policies to provide coverage for telehealth services.

Due to strong opposition from the insurance industry, neither House Bill 5313 nor Senate Bill 3319 were called for a vote in committee, but served as the starting point for negotiations. ISMS, along with the Illinois Hospital Association, successfully negotiated a compromise and amended Senate Bill 647 (Sen. Harmon/Rep. Feigenholtz). Through persistent negotiations

with representatives of the insurance industry, ISMS was able to achieve unanimous support in the House and Senate for this legis-lation, which for the first time sets forth a definition in the Illinois Insurance Code for telehealth services, meaning the delivery of covered health services by way of an interactive telecommunica-tions system. The bill sets forth many important protections for both patients and physicians providing telehealth services.

ISMS supported Senate Bill 647 as amended. The bill has been signed into law as Public Act 98-1091.

Prior Authorization House Bill 3638 (Rep. Fine/Sen. Kotowski) was introduced in the closing days of last year’s session. The bill would have required the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits by July 1, 2014. Beginning Jan. 1, 2015, or six months after the form is developed, every prescribing profes-sional would use that uniform prior authorization form to request prior authorization for coverage of prescription drug benefits.

ISMS requested that the Illinois Medicaid plan be exempted from the bill, which the sponsors agreed to. With this change, ISMS supported the bill.

However, during this session, the bill was amended, deleting the language creating the uniform prior authorization. Instead, language was added that requires all health insurers who sell plans on the exchange/marketplace to make information avail-able regarding a plan’s covered benefits. It also requires plans to publish a provider directory. The bill requires plans that are sold on the exchange marketplace to have a medical exceptions process for beneficiaries that allows prescribers to request any clinically approved prescription drug when any of the following occur: 1) the drug is not covered based on the plan’s formulary; 2) the plan is discontinuing coverage of the drug on the plans formulary; and 3) If other drugs have been ineffective or are likely to cause an adverse reaction.

ISMS opposed the bill as amended. The medical exceptions imposed are more cumbersome than the current ones in place. ISMS is also concerned with how clinical appropriateness will be determined by each plan. The bill also appears to prohibit or raise severe barriers to “off-label” prescribing. Finally, the bill as amended allows any request for exception or prior approval to be reviewed by undefined “health care professionals.”

House Bill 3638, as amended, has been signed into law as

year in review

Public Act 98-1035. ISMS intends to closely monitor how this law is implemented and will advocate for legislation to address problems that are likely to arise.

ALLIeD heALth CARe PROFessIONAL LICeNsURe

Dentists Providing Vaccines Senate Bill 3409 (Sen. Manar/Rep. Fine) and House Bill 5574 (Rep. Fine) would have allowed dentists to provide vaccines for shingles, HPV, hepatitis B, and influenza. This legislation was the top priority of the Illinois State Dental Society, which mounted a significant lobbying effort to secure its passage.

Due to ISMS opposition, Senate Bill 3409 now only allows dentists to provide flu shots to persons age 18 and over pursuant to a valid prescription or standing order by a physician, who in the course of their professional practice, administers vaccines to patients. The administration of the vaccine cannot be delegated to an assistant. The bill also contains several requirements to ensure that a physician continues to receive information about a patient’s vaccination history. A dentist is only authorized to provide the vaccine if contracted with and credentialed by the patients’ health insurance plan. Further, if the patient is a Medicare or Medicaid client, the dentist must be enrolled in those programs before providing a vaccine. Finally, the bill is now subject to an automatic sunset on Jan. 1, 2020.

ISMS was neutral on Senate Bill 3409 as amended. The bill has been signed into law as Public Act 98-0665.

Naturopath Licensure House Bill 3645 (Rep. Osmond) would have created the Naturopathic Medical Practice Act and provided for the regula-tion of “naturopathic physicians” through licensure by the Illinois Department of Financial and Professional Regulation. In the face of very strong ISMS opposition, the bill was never called for a vote in the House Health Care Licenses Committee.

Authorization to Administer the Meningococcal Vaccine Senate Bill 3277 (Sen. Althoff) amends the Pharmacy Practice Act to authorize pharmacists to provide the meningococcal vaccine to patients 10 through 13 years of age. This change would expand the range of ages of the patients to which pharmacists are currently allowed to administer this vaccine. Through the lobbying efforts of ISMS, the sponsor agreed to hold this legisla-tion and the bill did not advance beyond the committee level.

substitution of Biological Drugs Senate Bill 1934 (Sen. Munoz) amends the Pharmacy Practice Act to authorize a pharmacist to substitute a prescription biosimilar product for a prescribed biological product. Unlike with generic drug substitutions, the pharmacist must notify the patient’s physician after the substitution is made.

ISMS strongly supported this requirement, since biologics and biosimiliars are much more complex than other prescriptive drugs. The Illinois Retail Merchants Association opposed any physician notification requirement. Senate Bill 1934 passed out of the Senate Executive Committee, but because an agreement could not be reached on the physician notification language, it was not called for a full vote before the Senate.

Direct Access to Physical therapistsSenate Amendment 1 to Senate Bill 637 (Sen. Raoul) would have removed the current physician referral requirement for physical therapists for interventions by a physical therapist in an educational environment or in any environment where early intervention services are delivered, and for the purposes of pro-viding consultation, habilitation, screening, education, wellness, prevention, environmental assessment, and work-related services to individuals, groups, or populations. Due to quick intervention by ISMS in the midst of a hectic deadline week, this initiative did not advance beyond the committee level.

Dry Needling House Bill 1457 (Rep. Leitch/Sen. Clayborne) addressed how allowances were provided to residents in nursing homes. An amendment was introduced in the Senate, however, that would have allowed physical therapists to use dry needling or Intramuscular Manual Therapy in their treatments. On April 25, 2014, the Illinois Department of Financial and Professional Regulation concluded that dry needling is not within the scope of practice of physical therapists in Illinois. ISMS opposed this amendment, which was not adopted by the Senate and remains in the Senate Committee on Assignments.

Prescriptive Authority for Psychologists Senate Bill 2187 (Sen. Harmon/Rep. Bradley) would have granted clinical psychologists who have a doctorate in psychology and complete a master’s program in psychopharmacology the authority to prescribe drugs used in the treatment of mental, emotional, and psychological disorders. During last year’s spring session, Senate Bill 2187 passed the Senate despite strong opposition from ISMS, the Illinois Psychiatric Society (IPS), and other physician specialty groups, as well as patient advocacy groups such as the National Alliance for Mental Illness.

Last year, ISMS was successful in stopping the bill in the House. The advocates, however, were not only extremely aggressive in their lobbying efforts this year, but also filed a number of amendments that appeared to improve the bill, including strengthening the col-laborative agreement language to mirror what is required of APNs, as well as increasing the biomedical education and clinical training requirements to resemble those of a physician assistant. Legislators viewed these amendments as a major leap forward toward improv-ing the bill; however, ISMS and IPS remained opposed and insisted on additional limitations to protect patient safety.

Under an amendment insisted upon by ISMS and IPS, Senate Bill 2187 has the strictest and most comprehensive education and training requirements among the states that allow for this prescriptive authority.

In addition, the prescribing psychologist cannot prescribe to patients who are under 17 years of age or over 65 years of age, nor can they prescribe to anyone who is pregnant or has a serious medical condition, such as heart disease, stroke, or seizures, or anyone with developmental and intellectual disabilities. Prescribing psychologists are specifically prohibited from prescribing the fol-lowing: narcotics as defined in Section 102 of the Illinois Controlled Substances Act, benzodiazepines, and any Schedule II drugs.

These stringent requirements and restrictions are the direct result of strong efforts by ISMS and IPS. Our efforts received crucial support in the form of a generous grant from the AMA Scope of Practice Partnership.

ISMS and IPS were neutral on the bill as amended in the

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16 | Chicago Medicine | March 2015

House. The bill has been signed into law as Public Act 98-0668.

MeDICAL LIABILItY

statute of Limitations House Bill 5512 (Rep. Nekritz/Sen. Mulroe), an initiative of the Illinois Trial Lawyers Association, extends the statute of limita-tions in cases when a person is not under a legal disability at the time their cause of action becomes known, but becomes under a legal disability before the time limit expires.

ISMS expressed strong concerns about extending the statute of limitations and opposed the language as originally drafted. ISMS successfully advocated for an amendment clarifying that the statutes of repose, which set an ultimate time limit for bring-ing action, for medical or legal malpractice remain valid.

ISMS was neutral on the bill as amended. House Bill 5512 has been signed into law as Public Act 98-1077.

MeDICAL PRACtICe ACt

Child Abuse—Additional training Senate Bill 3421 (Sen. Morrison/Rep. Feigenholtz) in its introduced form would have required all licensed professionals who are mandated reporters under the Abused Neglected Child Reporting Act to complete a course in mandated reporter train-ing every five years. This mandate, which would have applied to over 30 licensed professions, including physicians, was strongly opposed by ISMS. ISMS was able to amend the bill to remove the educational mandate.

As amended, Senate Bill 3421 now provides that the Department of Financial and Professional Regulation must award continuing education credit for mandated reporters who complete the mandated reporter training provided by the Department of Children and Family Services. With this change, the bill now provides an incentive for additional continuing education credits for those who have a practice area to which this type of training is relevant.

ISMS supported Senate Bill 3421 as amended. The bill has been signed into law as Public Act 98-0850.

Physician Certification Verification House Bill 3661 (Rep. Flowers) would have required physicians applying for medical licensure in Illinois to submit support-ing documentation supplied by the Federation Credentials Verification Service, along with documents presently required by the Illinois Department of Financial and Professional Regulation (IDFPR).

ISMS opposed this legislation. Physicians already have to submit the same information to IDFPR during the licensure pro-cess. Requiring physicians to submit information to this service and have it sent to IDFPR would have cost new applicants an additional $350.

Due to ISMS opposition, House Bill 3661 failed in the House Health Care Licenses Committee.

Professional Discipline Senate Bill 232 (Sen. Haine/Rep. Nekritz) is an initiative of the Illinois Department of Financial and Professional Regulation that was amended significantly in order to address the concerns of ISMS. The bill originally created a vague, undefined standard for “good moral character” that could be used by the Secretary

of IDFPR as a basis to revoke the license of any licensee, includ-ing a physician. The impetus behind this legislation was several court cases when the Department had revoked a license, but the revocation was overturned by the circuit court.

Through the lobbying efforts of ISMS, the bill now simply codifies a provision of already existing administrative rules that addresses the factors that IDFPR must consider when determining whether a violation of a licensing act has occurred. The bill also references the current requirement for “good moral character” set forth in the Medical Practice Act.

ISMS was neutral on Senate Bill 232 as amended. The bill has been signed into law Public Act 98-1047.

Volunteer License House Bill 4593, an initiative of ISMS, allows physicians and other health care professionals who voluntarily practice at a free medical or public health clinic to be eligible for a license without fee to practice at such clinics. IDFPR expressed concerns about costs related to validating applications. The bill was amended to allow IDFPR to charge a nominal fee for any volunteer license granted after the first 500 free licenses.

ISMS supported House Bill 4593 as amended. The bill has been signed into law as Public Act 98-0659.

MeDICAL ReCORDs, PRACtICe AND ReGULAtION

Medically Necessary Prescriptions of Controlled substances House Bill 5527 (Rep. Reboletti) would have amended the Illinois Controlled Substances Act and would have penalized patients for knowingly withholding information from health care profes-sionals from whom a patient seeks to obtain a prescription for a controlled substance.

House Bill 5527 would also prohibited health care profes-sionals from prescribing controlled substances if such prescrip-tions are not medically necessary or prescribing an amount of controlled substances that is not medically necessary. House Bill 5527 would have made such actions a Class 4 felony for the first offense and a Class 3 felony for each subsequent offense.

ISMS opposed this bill, which was never called in committee.

Patient Access to extended-Release hydrocodone Amendment 1 to House Bill 4098, (Rep. Yingling) would have required patients who are prescribed a 90-day supply of an extended-release hydrocodone to attend an in-person visit with the initial prescribing physician.

ISMS opposed the bill as amended, which was not called on the House floor. The bill was re-referred to the House Rules Committee. electronic health Records exchange House Bill 5925 (Rep. Feigenholtz/Sen. Steans) is an initiative of the Governor’s Office of Health Innovation and Transformation (GOHIT) that encourages the use of electronic Health Information Exchanges (HIEs) and updates laws related to the disclosure of HIV-related information and genetic information.

House Bill 5925 establishes criteria under which health related information can be shared electronically. The bill also updates the definition of “informed consent” to include inform-ing a patient that his or her information may be shared with an HIE. Patients must be given an opportunity to opt-out of having

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March 2015 | www.cmsdocs.org | 17

their information shared. ISMS successfully advocated for an amendment that ensures

that professionals are afforded authority to share information by amending the Medical Patients’ Rights Act and the Code of Civil Procedure. ISMS also amended the immunity protections so they apply to both health care “providers” and “professionals,” and included professional immunity in sections that provide for civil and criminal immunity.

ISMS supported House Bill 5925 as amended. The bill has been signed into law as Public Act 98-1046.

hospital Discharges House Bill 5402 (Rep. Cloonen) would have created the Caregiver Advise, Record, and Enable Act. The bill would have required that before a patient is discharged from a hospital and no later than 24 hours after a patient enters a hospital, the hospital shall provide the patient or the patient’s legal guardian with the opportunity to designate a caregiver. The hospital would have to document the patient’s designation of a caregiver and provide instruction regarding after-care tasks to the caregiver. The hospital would have been required to notify the patient’s caregiver at least four hours before the patient is discharged.

ISMS opposed House Bill 5402, which never was assigned to a substantive committee and remains in the House Rules Committee.

Mandated testing for Cytomegalovirus House Bill 4199 (Rep. Nekritz) would have required the Illinois Department of Public Health to establish and maintain a public education program to inform pregnant women and women who may want to become pregnant about cytomegalovirus (CMV). The bill would have also required physicians treating newborns to test any newborn who fails a newborn hearing screening for CMV before the newborn is 21 days old and provide to the parents information regarding birth defects caused by congenital CMV and available methods of treatments.

ISMS, along with the Illinois Chapter of the American Academy of Pediatrics (ICAAP), supported creating a public education campaign, but opposed language mandating that physicians test for the virus, as this would legislate the practice of medicine.

Because of concerns expressed by both ISMS and ICAAP, the bill was not called for a vote in committee.

Mandatory testing for hepatitis C Senate Bill 2670 (Sen. Mulroe) creates the Hepatitis C Screening Act. This Act would have required physicians and facilities providing health services to offer a hepatitis C-related test to all individuals born between the years of 1945 and 1965.

ISMS opposed this legislation, which was partly initiated in response to guidelines issued in 2012 by the Centers for Disease Control and Prevention. The sponsor of this legislation held a “subject matter only” hearing on this legislation, at which ISMS and other groups offered testimony in opposition to this bill.

Given recent media attention regarding the prevalence of hepati-tis C in certain populations and issues associated with the high cost of treatment, this legislation will emerge again, either as a task force recommendation or to be considered on its own merits.

POLst Senate Bill 3076 (Sen. Mulroe/Rep. Feigenholtz) is an initiative

of ISMS to improve the current Department of Public Health “Do-Not-Resuscitate Advanced Directive” (DNR form). The initial goals of this legislation were to rename the form “Practitioner Order for Life Sustaining Treatment” or “POLST” form, and to authorize physician assistants, advanced practice nurses, and residents who have completed one year of residency to sign the form, in addition to physicians.

As this bill made its way through the legislative process, ISMS faced significant opposition from several groups, which was ulti-mately neutralized to secure successful passage. The Department of Public Health was reluctant to implement any changes to the form. While ISMS was able to work with the Department to address their concerns and obtain their neutrality on the bill, the Illinois Family Institute and other pro-life groups remained opposed to the legisla-tion. While unrelated to the changes sought by ISMS, these groups used this legislation as a means to discuss larger “end-of-life” issues and the existence of advance directives in general. However, with a strong effort by ISMS, SB 3076 received even more votes on concur-rence in the Senate than in the bill’s first vote in that chamber.

Senate Bill 3076 has been signed into law as Public Act 98-1110.

Power of Attorney for health Care Senate Bill 3228 (Sen. Haine/Rep. Williams) is an ISMS initia-tive to improve and streamline the Illinois Power of Attorney for Health Care form. The legislation set forth changes to the current form in order to create a form with much simpler language to help individuals trying to make health care planning decisions. ISMS was able to achieve consensus on this legislation by working with representatives of a variety of practice groups within the Illinois State Bar Association.

Senate Bill 3228 has been signed into law as Public Act 98-1113.

treatment of Unaccompanied Minors House Bill 4501 (Rep. Greg Harris/Sen. Steans) is an initiative of the Chicago Coalition for the Homeless, and was introduced to help homeless children obtain medical services. As originally drafted, the bill would have broadly defined “unaccompanied minor” to mean any minor who is living separate and apart from his or her parents or legal guardian, and is managing his or her own personal affairs. The bill would have permitted health care professionals to provide any type of treatment to a minor who represented himself or herself as an unaccompanied minor.

ISMS had serious concerns with how broadly the original bill was drafted. ISMS successfully amended the bill to allow physicians, APNs, and PAs to provide primary care to minors who, in the professional opinion of the health care professional, understand the risks and benefits of the primary care treatment being offered, and who provide in writing a statement attesting to the fact the minor is unaccompanied and seeking health care. This statement must be completed by an adult relative, social service agency, school social worker, attorney, or religious organization representative.

ISMS supported House Bill 4501 as amended, which has been signed into law as Public Act 98- 0671.

PUBLIC heALth

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year in review

18 | Chicago Medicine | March 2015

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the Attorney General’s office. The language expands the list of professionals who may administer epi-pens in schools to anyone trained on how to recognize and respond to anaphylaxis. School nurses and other trained personnel are authorized under House Bill 5892 to administer an epi-pen to anyone (not just a student) who they believe in good faith is having an anaphylactic reaction on school grounds or at a school function. The State Board of Education and the Department of Public Health will make mate-rials available for educating trained personnel on anaphylaxis.

The bill, as originally drafted, would have allowed advanced practice nurses without a collaborative agreement to prescribe epi-pens at a school. ISMS opposed this language and success-fully advocated for an amendment to delete it, clarifying that prescriptions or standing orders for epi-pens can only be written by a physician, physician assistant who has been delegated prescriptive authority for asthma medication or epinephrine, or an advanced practice nurse who has been delegated prescriptive authority for asthma medication or epinephrine. ISMS also secured immunity from civil, criminal, and professional liability for these health care professionals for any injury arising from the self-administration of asthma medication or the self- admin-istration or undesignated use of an epi-pen.

ISMS was neutral on the bill as amended. The bill has been signed into law as Public Act 98- 0795.

Mammography Reports House Bill 3765 (Rep. McAuliffe/Sen. Mulroe) as originally drafted would have required every provider of mammography services, in the instance of a patient’s mammogram demonstrat-ing dense breast tissue, to provide the patient a written summary of the mammography report stating that dense breast tissue makes it more difficult to identify cancer and may also be associ-ated with an increased risk of cancer.

ISMS opposed this language because this bill would legislate the practice of medicine. There is also no consensus within the sci-entific community on the relationship between breast density and cancer risk. Furthermore, there is no reliable method for assessing breast density, and no clinical guidelines that recommend additional screening solely on the basis of high breast density.

ISMS offered an amendment, which was adopted, stripping the bill of the mandatory report and replacing it with changes to the written summary on breast cancer currently published by Department of Public Health. The written summary, which already includes information on the meaning and consequences of “dense breast tissue,” will also inform patients of potential recommended follow-up tests and studies concerning dense breast tissue.

ISMS supported the bill, which has been signed into law as Public Act 98-0886.

Public self Care of Diabetes Senate Bill 3149 (Sen. Hunter/Rep. Welch) is an initiative of ISMS. The bill creates the Public Self Care of Diabetes Act. The new act provides that a person with diabetes, or parent or legal guardian of a person with diabetes, may self-administer insulin or administer insulin for his or her child in any location, public or private, where the person or their parent or legal guardian are authorized to be, irrespective of whether the injection site is uncovered during or incidental to the administration of insulin.

Senate Bill 3149 received unanimous support in both houses has been signed into law as Public Act 98-0844.

March 2015 | www.cmsdocs.org | 19

Medicare

“Building value-based initiatives on top of the currently broken Medicare fee-for-service system is like playing with a house of cards.”

UNPReCeDeNteD change is coming to the nation’s physicians in how they will be paid and evaluated. Chicago-area doctors will not be immune as the Medicare program

commits to shifting half its dollars away from fee-for-service medicine by 2018. For medical care providers, this means 50% of doctors will have payments eventually tied to performance, health outcomes of their patients and to other measures.

Though the payment vehicle may vary from an accountable care organization to a medical home, it’s clear that Medicare reimbursement for each and every test or procedure on a fee-for-service basis isn’t the way of the future and may soon be something for the health care history books.

Doctors will not be able to escape these changes because they are already underway at the Centers for Medicare and Medicaid Services (CMS), and are being adopted at an even faster rate by health insurance companies that contract with Medicare known as Medicare Advantage plans. “Three years ago, Medicare made almost no payments through these alternative payment models,” U.S. Secretary of Health and Human Services Sylvia Burwell said in announcing the federal government’s value-based payments in a perspective piece in the Jan. 26 issue of the New England Journal of Medicine.

But the percentage of payments being linked to value is rising rapidly.

Alternative Payment Model MomentumCurrently, just 20% of reimbursements from Medicare are made via alternative payment models like bundled payments, patient-centered medical homes and ACOs. A rapidly emerging care delivery system, ACOs reward doctors and hospitals for working together to improve quality and to rein in costs. In these models, doctors and hospitals take on more risk so that they can streamline the care, improve quality and eliminate bureaucratic inefficiencies.

“A majority of Medicare fee-for-service payments already have a link to quality or value,” Burwell said. “Perhaps even more important, our target is to have 30% of Medicare payments tied to quality or value through alterna-tive payment models by the end of 2016, and 50% of payments by the end of 2018.”

For example, the Medicare Shared Savings Program pays doctors through an ACO. If the providers in the ACO achieve better outcomes, they divvy up the money with Medicare or the

insurance company that owns the Medicare Advantage plan. The ACOs rely heavily on primary care doctors and their staffs, nurse practitioners and pharmacists for outreach to patients making sure they adhere to their prescriptions or wellness programs, stay healthy and out of the expensive hospital setting.

Physicians still Grappling with the sGR FormulaThe moves aren’t without controversy. Groups like the American Medical Association (AMA) and the Medical Group Management Association (MGMA), say they worry about these new ideas coming before the Obama administration and Congress have dealt with the flawed sustainable growth rate (SGR) formula in the existing fee-for-service program.

Though Medicare payment is moving away from fee-for-service payment, there will still be tens of thousands of doctors grappling with the SGR even if they are contracting through ACOs, patient-centered medical homes or in Medicare Advantage Plan networks. “Unfortunately, as it relates to Medicare physician payments, (Burwell’s announcement) distorts the signifi-cance of the administration’s past and projected program successes,” said Anders Gilberg, senior vice president of government affairs at MGMA in a statement to Chicago Medicine.

“Building value-based initiatives on top of the currently broken Medicare fee-for-service system is like playing with a house of cards,” he contin-ues. “In order to achieve real reform, Congress must pass the bi-partisan legislation it agreed to in principle, but did not enact in 2014. This legislation would realize significant value-based payment reforms and repeal the current SGR pay-ment system, which is scheduled to cut physician payments by 21% on April 1.”

But even if the Obama administration were to pull back on the shift, private insurers have no plans to do so because Medicare Advantage plans are aggressively moving away from fee-for-service payment.

Big Insurers Push Ahead on Value-Based CareAetna, UnitedHealth Group, Humana and Blue Cross and Blue Shield of Illinois are among the more dominant operators of Medicare Advantage in Chicago and the rest of the state. All of these plans, which were contacted by Chicago Medicine, say they are committed to the value-based care push.

Take Aetna, for example, which said it will

Medicare exits Fee-For-service The percentage of payments linked to value grows rapidly By Bruce Japsen

20 | Chicago Medicine | March 2015

Medicare

increase value-based payments to doctors and hospitals beyond the nearly one in three dollars already committed. “We continue to make great strides as we signed contracts with 28 new ACO partners since year-end 2013, launched multiple new products backed by ACO contracts, doubled our membership covered by value-based contracts to more than three million members, and increased the percent of our medical costs that run through value-based contracts to 28% of total spend,” Aetna chief executive officer Mark Bertolini told Wall Street analysts on the company’s fourth-quarter earnings call in February.

Bertolini said he’s pleased the federal govern-ment is open to partnering with the “private sector to get more value-based contracting underway,” given the health plan’s push. “We view this as posi-tive,” Bertolini said. “We are not quite sure about the details yet.” But Bertolin said Aetna would like to see the value-based efforts of the government “go faster and bigger.”

Other private insurers are thinking the same way. UnitedHealth Group has said it would increase payments that are tied to value-based arrangements to $65 billion by the end of 2018. At Humana, the Louisville, Kentucky, based insurer said it expects to have 75% of its members covered under value-based relationships by 2017. “As of Dec. 31, 2014, we have 42,300 primary care providers in value-based relationships and 1.3 mil-lion Medicare Advantage members served under value-based arrangements,” Humana spokesman Tom Noland said.

Humana and other insurers say they work on more upfront outreach to patients, encouraging them to get into their primary care doctor’s office. “Our wellness efforts have a strong focus on gaps in care. In 2014, we closed approximately 4.3 million gaps in care for our members, driven by improvements in preventative screen-ings,” Humana Chief Executive Officer Bruce Broussard said in February on the company’s earnings call. “Better still, we are very pleased that approximately 1.3 million of our members across all lines of business received preventative treatment on schedule.”

the early Results from Major Physician Groups and hospitals So far, among the major doctor and hospital groups already working with Medicare Advantage plans via value-based payment, the results seem to be working in the favor of shared savings for providers. Take Advocate Health Care, Illinois’ largest provider of medical care, which has Medicare Advantage contracts with Aetna’s HMO, Blue Cross and Blue Shield of Illinois’ HMO, Humana’s HMO and PPO, United Medicare Advantage and plans operated by Cigna and Wellcare.

“Advocate’s financial performance for the

first 18 months of the Medicare Shared Savings Program (MSSP) resulted in an expenditure decrease of -0.2% from the benchmark year,” Advocate Vice President Kelly Jo Golson said in a statement to Chicago Medicine. “The trend for Advocate was a 0.2% reduction below the national trend. Most of our progress was made in the final six months of the reporting period, which confirmed that we are on the right track.”

There were some bugs Advocate executives said they initially had to work out with the Centers for Medicare and Medicaid Services. “We didn’t receive clean data from CMS until 14 months into the program, which made it difficult to be sure we were applying our population health strategies to the right patients,” Golson said. “We are now in a better position to do so.”

More broadly, Advocate says the organization is a big supporter of value-based reimbursement beyond the Medicare Shared Savings Program and its contracts with Medicare Advantage plans. In fact, the group sees value-based reim-busement as the future.

“Currently, over two-thirds of the revenue at Advocate hospitals is tied to value-based reim-bursement and Advocate’s risk-adjusted medical cost of care growth for these programs is better than market,” Golson said.

More specifically, we are seeing substantial progress in reducing length of stay, a lower mor-tality index, expanded eICU services, the launch of a coordinated behavioral health strategy and community health worker initiative along with more than 50 of our outpatient sites receiving Patient Centered Medical Home (PCMH) recognition.”

Judging enthusiam for the trend Whether the rest of Chicago’s medical-care providers will share Advocate’s enthusiasm is unclear. But they might not have a choice if such trends continue.

Blue Cross and Blue Shield of Illinois, for example, has long been a proponent of value-based care and in 2013 began offering Medicare Advantage products. “We offer a variety of PPO and HMO products in our markets,” Illinois Blue Cross spokes-woman Maryann Schultz said. “This is a relatively new initiative for (the company). We’re always look-ing for ways to keep members “Blue for Life” and since their introduction, we’ve seen a high demand for our Medicare products and services.”

With results like these from the state’s largest insurer, it may not be long before the rest of health care falls in line.

Bruce Japsen is an independent health care journalist who writes for Forbes and contributes analysis to WBBM Newsradio and WTTW television in Chicago and Fox News Channel’s Forbes on Fox. He can be reached at brucejapsen@gmail.com.

“even if the Obama administration were to pull back on the shift, private insurers have no plans to do so because Medicare Advantage plans are aggressively moving away from fee-for-service payment.”

March 2015 | www.cmsdocs.org | 21

member benefits

Tina Shah, MD, MPh, a fellow at the Univer-sity of Chicago, will never forget the exhilaration of testifying before a U.S. senator. Seated in the Capitol Building, across from Sen. Richard Durbin, Dr. Shah had the attention of a major legislative leader who

listened as she relayed the fears of U.S. medical students and trainees. Many physicians of tomorrow, Dr. Shah stressed, won-der if they really have a future in medicine.

Dr. Shah, who was part of the Chicago Medical Society team in Washington on Feb. 23-25, gave voice to thousands of her peers. Both she and CMS President-elect Kathy M. Tynus, MD, also got a commitment from Senator Durbin that he would support the “Resident Physician Shortage Reduction Act,” a bill co-sponsored in 2013 by Senator Charles Schumer of New York, if the bill is reintroduced this year.

Because of the five-year training pipeline, Congress must raise the residency cap without delay, with funding to support existing and new programs, the two physicians emphasized. Dr. Shah gave the Senator some shocking details.

“The downsizing and closure of residency programs mean

that trainees can be accepted into a program or even in their first or second year of residency, and suddenly their world collapses. For some, it’s next to impossible to get into another program,” Dr. Shah said. “There’s no algorithm for matching a person with more than a year of residency training. The match isn’t open to someone with partial training.”

Dr. Shah, a fellow in pulmonary medicine and critical care, is chair of the Resident and Fellow Section of the American Medical Association. In that role, she represents over 38,000 of her peers. She reports getting emails from young physicians about training-related issues, including abrupt program closures.

Having the ear of the Senate Minority Whip gave me “vali-dation,” Dr. Shah says. Medical residents seldom get this kind of experience in the hospital. Lawmakers rarely talk to those in the thick of training, she observes. For Dr. Shah, speaking up is her civic duty.

In 2013, an estimated 528 graduates failed to land a residency spot. Dr. Shah cited the case of a friend in New York who was pursuing anesthesiology when her program closed during her second year. As a non-first year trainee, the friend

Your Society Makes its Mark in WashingtonFellow relays concerns of medical students to top legislator

Dr. Wei Wei Lee of the University of Chicago leads an interactive CME workshop at the Chicago Medical Society on Feb. 10.

CMS meets with U.S. Senator Richard Durbin in his Capitol Building office. CMS got a commitment from the senator that he will add his name to the “Resident Physician Shortage Reduction act,” a 2013 bill that CMS wants to see reintroduced this year. Shown from left are: President-elect Dr. Kathy M. Tynus; Senator Durbin; Srinu Sonti (legislative assistant to Senator Durbin); and Dr. Tina Shah.

22 | Chicago Medicine | march 2015

member benefits

How CMS Advocates for GMEWoRKing BoTh sides of the political aisle, the Chicago medical society met with numerous lawmak-ers while in Washington, DC, last feb. 23-25. A major achievement for Cms came when U.s. senator richard Durbin gave his word that he will put his name on a senate bill that reduces resident shortages (see photo).

And when not physically present on Capitol Hill, our bipartisan efforts live on. in recent months, Cms has widened its advocacy scope, communicating with key lawmakers across the U.s.

Our national outreach includes:

• Reps.KathyCastor(D-FL)andJoe Heck (r-nV), sponsors of the bipartisan Creating Access to residency education (CAre) Act. this bill would boost the number of resident physicians through creative partnerships with health providers. the CAre Act also provides a timely response to two recent studies that highlight the troubling shortage of doctors in training.

• Sens.BillNelson(D-FL),Charles schumer (D-nY), the original cosponsors of the “resident Physician shortage reduction Act.”

• Reps.JoeCrowley(D-NY)andmike Grimm (r-nY), the original House sponsors of the “resident Physician shortage reduction Act of 2013.”

• Rep.KathyCastor(D-FL),anoriginal sponsor of the “training tomorrow’s Doctors today Act.”

• Sens.RichardDurbinandMarkKirk.• Rep.TomPrice(R-GA).• U.S.House“DoctorsCaucus,”and

its co-chairman Phil roe (r-tn) about Gme needs in illinois, and the impact on training as a result of the 1997 cap.

could not fit into the match. Eventually she placed into a program, narrowly escaping having to repeat her training.

Dr. Shah also reports the case of a medical school graduate lined up to interview but the program closed without warning only a few days before the interview. Others have experienced programs shutting down even

during the interviewing process. In her own University of Chicago program, Dr. Shah said

there is a clinical need for additional fellows, not to mention excellent learning opportunities awaiting such individuals. However, the lack of funding for more positions is a direct consequence of the GME cap. The shortage also increases the stress on remaining fellows, she notes.

What happens when bright altruistic young people come out of medical school, assuming they have a place to go, and find out their path is closed? Dr. Shah advises them to remem-ber that funding is not guaranteed throughout the duration of their training.

Until reforms come to the GME system, Dr. Shah urges young members to write to their elected officials in Congress and to advocate through their professional societies such as CMS.

While on Capitol hill, the advocacy team visits with U.S. house Budget Committee Chair Tom Price of georgia. Shown from left are: Drs. Raj B. Lal; Kathy M. Tynus; Representative Price; CMS President Dr. Kenneth g. Busch; Dr. Shah.

march 2015 | www.cmsdocs.org | 23

member benefits

aFTER yEaRS of short-term patches, the news from Washington is that lawmakers appear close to ending the annual SGR cliffhanger. As this magazine went to press, the U.S. House had indeed resoundingly passed HR 2, the “SGR Repeal

and Medicare Provider Payment Modernization Act of 2015,” in advance of the March 31 deadline.

The Senate was on track to take up the measure after Congress returns from a two-week recess, raising the possibility of prompt passage in mid-April. President Obama also expressed support for the idea of a “fix.”

But should physicians get their hopes up?Congress created the fatally flawed SGR formula back in 1997

as a means to control health care spending. Whenever the cost of health care exceeds the GDP, the SGR kicks in with automatic pay cuts. Since 2003, lawmakers have applied 17 temporary pay patches to stop these reductions. This year’s threatened cuts come to 21%.

The Chicago Medical Society has made SGR repeal one of its highest legislative priorities. Over the years, our advocacy team in Washington has relentlessly pushed Medicare reform on several fronts, particularly the right of physicians to bal-ance bill their patients and for appropriate funding of gradu-ate medical education. As physician shortages loom, we have catapulted workforce expansion to the top of our advocacy agenda (see page 26.)

The HR 2 package repeals the SGR formula and ends the yearly threat of pay cuts to physicians. Costing $214 billion over the next ten years, the bill adds $141 billion to the federal deficit,

according to Congressional Budget Office estimates. Roughly $70 billion would be paid for through higher premiums on wealthier Medicare beneficiaries, and reimbursement changes for hospitals and other providers.

The legislation also institutes a 0.5% payment increase for five years while Medicare shifts doctors to a value-based care system. Physicians would be required to receive at least 25% of their Medicare payments through Alternative Payment Models by 2019-2020.

Other HR 2 features include changes in federal policy on health information technology. For example, doctors who meet meaningful use requirements for EMRs would earn a bonus. HR 2 also would reward remote patient-monitoring and telehealth as clinical practice improvement activities. The bill extends the Children’s Health Insurance Program for two years. Senate demo-crats strongly favor a four-year extension of CHIP.

The federal CMS has said it can delay the 21% cuts for two weeks, holding claims for 10 business days.

SgR Reality The SGR saga has been part of physicians’ lives for 18 years, with 17 pay patches since 2003. Members of Congress have always understood that failure to approve a patch, allowing pay cuts to take effect, would create catastrophic access to care problems for seniors when physicians could no longer afford to care for them. Lawmakers want to avoid accountability for such a scenario, and the prospect of not being re-elected to office.

Simply put, we should not rule out an 18th pay patch.

Will Congress Deliver the “Doc Fix”?House approves bipartisan SGR repeal and replacement, but will the discord end?

Governor Pledges Support to MedicineIllinois Governor Bruce Rauner (center) met with Dr. Kenneth G. Busch, CMS president, and Dr. Anne Szpindor, CMS trustee, during the recent annual dinner and gala of the Polish American Medical Society (PAMS). During their conversation, the gover-nor, who was a guest of honor at the event, along with Dr. Busch, told the two physicians that he is a friend of medicine, and that liability reform is a top priority for him. Dr. Szpindor is a past president of PAMS.

Ald. Margaret Laurino Addresses CMS BodySeeking input from the Chicago Medical Society, Ald. Margaret Laurino, City Council president pro tempore, spoke before the CMS Governing Body on Feb. 10. In her address, Alderman Laurino noted that CMS has worked with numerous City Council members over the years on health policy and regulation. The alderman said she hopes to build on that relationship. Opinions from the medical community are important when it comes to allocating city resources, Alderman Laurino concluded.

24 | Chicago Medicine | march 2015

http://www.docbookmd.com

member benefits

aPRiL

8 iCD-10 CM: Preparing for a Successful implementation Intended for all physicians, practice managers, physician executive staff, and medical office staff. A successful transition to ICD-10 CM by Oct. 1, 2015, will require careful planning and coordination of resources. Numerous provider and health plan databases and applications will be affected–including applications where diagnosis or procedure codes are captured, stored, analyzed or reported. In this session, participants will learn to describe the key plan elements required for a successful transition; make recommendations for each of the four implementation phases (planning, impact analysis, implementation, and post-implementation); discuss the code structure, format and basic conventions of ICD-10-CM diagnosis coding; and understand its impact. Speaker: Nelly Leon-Chisen, RHIA, director, coding and classification, American Hospital Association, Chicago. Registration/breakfast: 8:30- 9:00 a.m.; presentation: 9:00 a.m.–12:30 p.m. The Hyatt Lodge at McDonald’s Campus, 2815 Jorie Blvd., Oak Brook. Up to 3.5 CME credits; $59 per person for CMS members; $159 for non-members or staff. Register online at: www.cmsdocs.org or contact Elvia at emedrano@cmsdocs.org or call 312-670-2550, ext. 338.

15 CMS Executive Committee Meeting Meets online once a month to plan Council meeting agendas; conduct busi-ness between quarterly Council meetings; and coordinate Council and Board functions. 8:00-9:00 a.m. For information, contact Ruby 312-670-2550, ext. 344; or rbahena@cmsdocs.org.

15 To Panel or not to Panel: The Changing Landscape of Cancer genetics in the genomics Era, by Peter hulick, MD This event is hosted by the Chicago Gynecological Society 6:00 Registration; 7:00 Dinner and Lecture; Maggiano’s Banquets, 111 W. Grand Ave., Chicago. Cost: one dinner credit for CGS members; $75 for non-members. To register and pay, go to www.chicagogyn.org/schedule. For more information or questions, call 312-670-2550.

16 Vertical Scar Breast Reduction, by Frank Lista, MD This event is hosted by

the Illinois Society of Plastic Surgeons. 6:30 Cocktails and Registration; 7:00 p.m. Dinner and Lecture; Willis Tower Metropolitan Club, Michigan Room on 66th Floor, 233 S. Wacker Dr., Chicago. Members may attend at no cost. To RSVP, please call 312-670-2550.

17-19 iSMS house of Delegates The policymaking body of the Illinois State Medical Society meets at the Oak Brook Hills Marriott Resort, 3500 Midwest Rd., Oak Brook. For more information, please contact www.hod@isms.org or call 312-853-4745 or 800-782-4767, ext. 4745.

May

1 iCD-10 CM: Preparing for a Successful implementation Intended for all physicians, practice managers, physician executive staff, and medical office staff. A successful transition to ICD-10 CM by Oct. 1, 2015, will require careful planning and coordination of resources. Numerous provider and health plan databases and applications will be affected–including applications where diagnosis or procedure codes are captured, stored, analyzed or reported. In this session, participants will learn to describe the key plan elements required for a successful transition; make recommendations for each of the four implementation phases (planning, impact analysis, implementation, and post-implementation); discuss the code structure, format and basic conventions of ICD-10-CM diagnosis coding; and understand its impact. Speaker: Nelly Leon-Chisen, RHIA, director, coding and classification, American Hospital Association, Chicago. Registration/breakfast: 8:30-9:00 a.m.; presentation: 9:00 a.m.–12:30 p.m. Chicago Medical Society, 33 W. Grand Ave., Chicago. Up to 3.5 CME credits; $59 per person for CMS members; $159 for non-members or staff. Register online at: www.cmsdocs.org or contact Elvia at emedrano@cmsdocs.org or call 312-670-2550, ext. 338.

10 Stop the Clot Chicago 5K Run/Walk. The National Blood Clot Alliance along with race director Christina Martin are hosting this event to educate the Chicago area about the dangers of blood clotting disorders. 9:00 a.m., Montrose Ave. Beach, 4400 N. Lake Shore Dr. For more information, please call 641-715-3900, ext. 593533, or visit www.stoptheclotchicago.com.

12 CMS Board of Trustees Meets every other month to make financial decisions on behalf of the Society. 5:00-6:00 p.m. (prior to the Council meeting); Maggiano’s Banquets Chicago, 111 W. Grand Ave. For information, contact Ruby 312-670-2550, ext. 344; or rbahena@cmsdocs.org.

12 CMS annual Dinner/governing Council Meeting The Society’s governing body meets four times a year to conduct business on behalf of the Society. The policymaking Council considers all matters brought by officers, trustees, committees, councilors, or other CMS members. Following the Council meeting, CMS will welcome the 2015-2016 leadership team and president awards to outstanding members. 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, please contact Ruby 312-670-2550, ext. 344; or rbahena@cmsdocs.org.

13 CMS Executive Committee Meeting Meets online once a month to plan Council meeting agendas; conduct busi-ness between quarterly Council meetings; and coordinate Council and Board functions. 8:00-9:00 a.m. For information, contact Ruby 312-670-2550, ext. 344; or rbahena@cmsdocs.org.

20 Resident Paper Competition This event is hosted by the Chicago Gynecological Society. 6:00 Registration; 7:00 Dinner and Lecture; Maggiano’s Banquets, 111 W. Grand Ave., Chicago. Cost: one dinner credit for CGS members; $75 for non-members. To register and pay, go to www.chicagogyn.org/schedule. For more information or questions, call 312-670-2550.

21 high Volume Fat grafting This event is hosted by the Illinois Society of Plastic Surgeons. 6:30 Cocktails and Registration; 7:00 p.m. Dinner and Lecture; Speaker: Louis P. Bucky, MD; Willis Tower Metropolitan Club, Michigan Room on 66th Floor, 233 S. Wacker Dr., Chicago. Members may attend at no cost. To RSVP, please call 312-670-2550.

30 Midwestern association of Plastic Surgeons 54th annual Scientific Meeting 7:00-6:00 p.m.; Northwestern Memorial Hospital, 251 E Huron, Chicago. To register and pay go to https://maps2015.eventbrite.com.

Calendar of Events

26 | Chicago Medicine | march 2015

Personnel Wanted

Anesthesiologist, board-eligible or board-certified needed, part-time for Family Planning Surgical Centers in Chicago, Northwest suburbs and West suburban Chicago, Ill., area. Early morning to mid-afternoon hours one to four days a week available. Please send resumes to administration@officegci.com and/or vg1028@aol.com and by fax to 847-398-4585.

Ob-gyn physician wanted to perform surgeries, D & C, laparo-scopic tubal sterilization, hysteroscopy and other gynecological procedures part-time (25-30 hrs.) in Family Planning Surgical Centers in Chicago, Northwest suburbs and West suburban Chicagoland area. Must be within 50 miles of Chicagoland area. Please fax CV to 847-398-4585 or administration@officegci.com and/or vg1028@aol.com.

office/Building for Sale/Rent/Lease

Great opportunity for a physician—medical office for rent. South Side Chicago building (69th and Ashland) has medical/dental/pharmacy/ultrasound/lab. Expenses are shared; very low over-head. Loyal patients for 40 years. Contact Dr. Patel 847-682-9021 or email drrsdental@gmail.com.

For sale: Freestanding multi-specialty surgery center in Wood Dale, Ill., with ample parking. State-licensed ASC with one larger and one smaller operating room, 3,800-4,000 sq. ft. Asking $4.75 million, not including real estate. Serious inquiries only. Email Administration@officegci.com and vg1028@aol.com or fax: 847-398-4585.

For sale: Medical office/urgent care facility; 1650 Maple Ave., Lisle; 1,500-4,000 sq. ft. available. Single story, 20-30 car park-ing lot. Asking $799,000. Email kimberleeo@officegci.com and/or fax: 847-398-4585.

For sale: Plastic surgery/pain management medical office; 736 N. York Rd., Hinsdale. Building area (approx.) 3,200 sq. ft. Large operating room and recovery room. Single story, freestanding building, ample parking. Asking $859,000. Email administra-tion@officegci.com or vg1028@aol.com. Fax: 847-398-4585 with serious inquiries.  

Business Services

Physicians’ Attorney—experienced and affordable physi-cians’ legal services including practice purchases; sales and formations; partnership and associate contracts; collections; licensing problems; credentialing; estate planning; and real estate. Initial consultation without charge. Representing practitioners since 1980. Steven H. Jesser 847-424-0200; 800-424-0060; or 847-212-5620 (mobile); 2700 Patriot Blvd., Suite 250, Glenview, IL 60026-8021; shj@sjesser.com; www.sjesser.com.

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District 6Walter J. mcCarthy iii, mDDavid J. sklar, mD

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march 2015 | www.cmsdocs.org | 27

RiChaRD W. ByRnE, MD, gets more done in one day than most people do in a week—or more. For starters, Dr. Byrne serves as professor and chairman of the department of

neurosurgery at Rush Medical College, and as medi-cal director of University Neurosurgery at Rush University Medical Center. He has served in various neurosurgical capacities at the College and RUMC for the last 24 years, starting with a surgical intern-ship in 1991.

Dr. Byrne’s stint in neurosurgery started early on. During his first week at Northwestern University Medical School, where he received his MD in 1991, Dr. Byrne attended a faculty dinner where he met two neurosurgeons—J. Thomas Brown, MD, and Leonard Cerullo, MD. “They invited me to visit the OR and I was immediately struck by the work they were doing,” he says. “So much so that I played a lot of hooky from medical school to go to the OR instead!”

Senior physicians continued to have an impact on Dr. Byrne’s career. “I saw a brain mapping operation for a tumor by George Cybulski, MD, at Northwestern, that I found amazing,” he says. “I knew I had to learn to do that.”

The young physician was told to study under Walter Whisler, MD, and Richard Penn, MD, at RUMC during his residency if he wanted to learn more about the procedure—which is exactly what he did. Coincidentally, later, Dr. Cerullo became the chairman of the department of neurosurgery at Rush Medical College. “When he stepped down, I took over as the acting chairman,” says Dr. Byrne. “And I’ve been there ever since.”

Of his accomplishments at Rush, Dr. Byrne is proudest of the team he has assembled in the neu-rosurgery department. “I like to think that we are the best neurosurgery department in the Chicago area,” he says, “but you can’t dispute the fact that we are the busiest. It’s a great feeling that, when a friend or relative asks for a recommendation for a neurological surgeon, all I have to do is look down the hallway to find the answer.”

For clinical work, Dr. Byrne, a subspecialist in brain tumors and the surgical treatment of epi-lepsy, maintains a full operating schedule. “When it comes to patient care, I’m always happiest about the patients I have most recently treated,” he says. “Yesterday I did five craniotomies. So today I’m happiest that those five patients are doing well. I just take it one step at a time.”

In addition to his duties at Rush, Dr. Byrne is past president of three medical organizations and directs two national courses for the Society of Neurological Surgeons that every U.S. resident must attend. And then there is his personal life, where sports play a huge role—he’s currently training for his third Ironman length triathlon. His daughters are also avid athletes—15-year-old Nika enjoys tennis and 14-year-old Kayla is an accomplished runner—both are sports that he participates in with them. The whole family, including his neurologist wife Armita Bijari, MD, work throughout the year on brain tumor fundraisers.

So what’s next? “I’m trying to answer that myself,” he says. “I definitely want to continue to work on our department. But I also want to improve neurosurgery as a whole. I’m currently working on three submitted patents and two textbooks.” Despite his full schedule, there’s no doubt Dr. Byrne can manage to squeeze in just a few more goals.

WHO’s WHO

no Time to WasteNeurosurgeon lives life to the fullest By Cheryl england

Dr. Byrne’s Career Highlightsa SKiLLED PhySiCian and accomplished researcher, Dr. Byrne is also a passionate teacher responsible for training 14 neurosurgery residents and fellows each year at Rush. A born leader, Dr. Byrne belongs to numerous medical societies, including CMS, and is the past president of the Illinois State Neurosurgical Society and the Chicago Neurological Society, current treasurer of the Neurosurgical Society of America, and chairman of the Interurban Neurosurgical Society. His honors include the career achievement award for brain tumor surgery from the Chicago Neurological Society, the Gary Lichtenstein Humanitarian Award from Voices Against Brain Cancer, and the Roger C. Bone, MD, Presidential Endowed Chair at Rush, a position he currently holds.

as chairman of the department of neurosurgery at Rush, Dr. Richard Byrne has a hectic schedule. But it doesn’t stop there—in fact, far from it.

28 | Chicago Medicine | march 2015

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